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小儿创伤性下肢血管损伤的管理

Management of pediatric traumatic lower extremity vascular injuries.

作者信息

Fairman Alexander S, Notrica David M, Dalsing Michael C, Coleman Dawn M, Pascarella Luigi

机构信息

Department of Pediatric General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.

Division of Pediatric General Surgery, Phoenix Children's Hospital, Phoenix, AZ.

出版信息

J Vasc Surg. 2025 Aug;82(2):383-390. doi: 10.1016/j.jvs.2025.04.031. Epub 2025 Apr 28.

Abstract

BACKGROUND

Pediatric lower extremity vascular injuries are challenging to manage and treat. Early recognition and a high index of suspicion is needed to ensure accurate diagnosis and timely interventions to prevent limb loss. These injuries present numerous technical challenges to the surgical multidisciplinary team, particularly in a very young patient. Technical challenges relate to small vessel size, vasospasm, and at times the lack of a suitable conduit for vascular reconstructions. The literature describing accepted clinical algorithms and techniques to manage these patients and their injuries are sparse. Moreover, there is significant variability in clinical specialties involved in their care.

METHODS

A thorough literature review was performed on pediatric lower extremity traumatic injuries. Iatrogenic injuries were not included in this review. Expert opinion of those who routinely intervene on pediatric lower extremity traumatic injuries was also considered.

CONCLUSIONS

The goal of this review was to summarize different injury patterns and promote management strategies that have been successful among practitioners experienced in managing pediatric extremity vascular trauma.

摘要

背景

小儿下肢血管损伤的处理和治疗具有挑战性。需要早期识别并保持高度怀疑指数,以确保准确诊断和及时干预,防止肢体丧失。这些损伤给外科多学科团队带来了诸多技术挑战,尤其是对于非常年幼的患者。技术挑战涉及血管管径小、血管痉挛,有时还缺乏适合血管重建的管道。描述处理这些患者及其损伤的公认临床算法和技术的文献很少。此外,参与其护理的临床专科存在很大差异。

方法

对小儿下肢创伤性损伤进行了全面的文献综述。本综述不包括医源性损伤。还考虑了经常干预小儿下肢创伤性损伤的专家的意见。

结论

本综述的目的是总结不同的损伤模式,并推广在处理小儿肢体血管创伤方面经验丰富的从业者中已取得成功的管理策略。

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